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Project Date

January 2009 - Present

Abstract

Comprehensive care can be provided to patients with visceral leishmaniasis by applying Roy’s theory in association with systematized nursing assistance. Objective: To study a case of visceral leishmaniasis using Roy’s Adaptation Model. Method: The study was conducted from March to April 2008 within the scope of the ‘Sign and symptom interpretation and Semiology’ course in an undergraduate Nursing program in Campo Grande, Mato Grosso do Sul, in southwestern Brazil. Roy’s theory was applied to a hypothetical case of visceral leishmaniasis. Nursing students were expected to relate this model to their already acquired knowledge of parasitology. Results: Focal stimulus—Visceral leishmaniasis has in Leishmania chagasi its etiological agent, which is transmitted through blood meals taken from animal reservoirs by sand flies (Lutzomyia longipalpis). Contextual stimulus—Encompasses endemic region, availability of reservoirs (dogs, foxes, opossums), and age range and nutritional and immunological status of the infected patient. Once inoculated by the insect vector into humans, L. chagasi promastigotes reach the bloodstream and are phagocytized by mononuclear phagocytic cells, where they adapt to the intracellular environment and transform into amastigotes, which undergo binary fission until the host cell ruptures. Released in the bloodstream, the protozoans migrate to organs such as the liver and spleen, causing hepatosplenomegaly, fever, diarrhea, dry cough, weakness, and inappetence, which in turn lead to malnutrition and anemia, affecting the immune system and opening the door to opportunistic infections. Residual stimulus—The infected individual experiences feelings of imminent death, insecurity, apathy, and sorrow. Coping mechanisms—Innate and acquired regulator (physiological) and cognator (psychosocial) mechanisms are activated. Physiological, psychic, social, and affective needs are all affected by the parasitosis. The role of nurses is, in conjunction with other healthcare professionals, to promote the interaction of patients with the environment, enabling them to overcome compensatory or compromised levels of adaptation and regain comprehensiveness. In conclusion, viewing the individual’s structure as an adaptive system according to Roy’s model capacitates nursing students to plan effectively the nursing assistance to be delivered to these patients.
Keywords: visceral leishmaniasis, nursing, Roy’s model.